| NPI | 1285104661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TY JUSTICE Director, Payer Relations 513-808-4984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2018-11-28 |